Organization
PALOS MEDICAL GROUP, LLC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TERRENCE C MOISAN (PRESIDENT, CEO)
(708) 923-5000
Entity
Organization
Contact information
Practice address
15300 WEST AVE, ORLAND PARK, IL 60462-4600
(708) 590-5304
(708) 590-5308
Mailing address
12251 S 80TH AVE STE 1630, PALOS HEIGHTS, IL 60463-1256
(708) 923-5173
(708) 923-5018
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
36102101
—
IL
Enumeration date
12/18/2009
Last updated
01/26/2024
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